City of Providence 2023 Providence Police Department Sports Academy - Basketball Registration

Basketball Participant Registration

August 14th-18th 2023
8:30AM-2:30PM
Classical High School Gymnasium

Space is limited.
Ages 6 and up

Please note: Parents/Guardians will receive a phone call/email confirming acceptance to camp.

Youth Participant Information

Participant's Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Home Phone(Required)

School Attends(Required)

Grade(Required)

Age(Required)

Gender(Required)

Male

Female

Birthdate(Required)

Parent/Guardian Information

Parent/Guardian Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Home Phone(Required)

Cell Phone(Required)

Email(Required)

Emergency Medical Attention Information

Medical Concerns

Please describe any medical/physical conditions which staff should be aware of. Please include any dietary restrictions, allergies, chronic health conditions, and/or medications.

Emergency Contact #1 Name(Required)

Emergency Contact #1 Relationship(Required)

Emergency Contact #1 Phone(Required)

Emergency Contact #2 Name(Required)

Emergency Contact #2 Relationship(Required)

Emergency Contact #2 Phone(Required)

Permission/Consent

CAPTCHA